When will U.S. health insurance cover medical cannabis?

Healthcare coverage for cannabis treatments is still a distant dream in the United States.

But in some states, medical cannabis patients may soon be reimbursed for doctors’ visits, cannabis products and other MMJ-related services via a workaround, one advocacy organization said this week.

Participants in a recently announced reimbursement program called Elevated States could receive up to $175 per month in reimbursements for medical cannabis and related doctor visits, said Gennaro Luce, CEO of EM2P2, a digital healthcare platform.

The potential cost savings for cannabis-centered therapies comes at the same time as steep increases in overall healthcare costs loom amid a squabble in Washington over Obamacare subsidies.

“Insurance is going to skyrocket this year and next, and these plans are very competitive,” Luce said.

Major insurers such as Cigna, Detego Health and Envita Health are offering the benefit in some of their healthcare packages in the 38 states where medical marijuana is legal, according to the American Council of Cannabis Medicine (ACCM), which is administering the arrangement.

Doug Benns, a consultant who is a member of the ACCM’s executive committee, estimates that 15 insurance companies will be part the program by the time open enrollment begins Nov. 1.

The reimbursements will cover for a variety of MMJ-related services, he said.

“Some will pay for the doctor visit, some will pay for expenses at the dispensaries, some for both,” Benns told MJBizDaily.

Not quite insurance coverage for medical cannabis

Despite medical marijuana’s wide acceptance in the United States – and court decisions that have required states to cover cannabis treatment in workers’ compensation cases – lingering federal cannabis prohibition means insurers are leery about touching cannabis.

That’s created difficulties for cannabis patients seeking any kind of help from their insurance providers.

The belief that insurance will cover medical marijuana will generate buzz. But to Steph Sherer, founder and president of MMJ patient advocacy group Americans for Safe Access, the reality doesn’t quite match the hype.

While some companies are talking about frameworks for reimbursement and employee benefits, there’s no actual insurance company currently covering cannabis, she said.

What’s being marketed as “coverage” often boils down to employee discount programs, similar to perks like gym memberships or acupuncture discounts, Sherer said.

These programs might offer patients reduced costs at dispensaries or with cannabis specialists, but they’re far from the comprehensive coverage many are hoping for, she added.

Workers’ compensation programs in a few states have piloted reimbursement models, but they are not indicative of a broader trend.

How healthcare could revitalize the medical cannabis market

Still, any reimbursement for MMJ patients is expected to give a much-needed shot in the arm to the medical marijuana industry.

The number of medical marijuana patients on average decreases by roughly one-third after a market launches recreational sales, according to data from the Washington, D.C.-based Marijuana Policy Project.

“This is going to add a lot of strength to medical cannabis to have big, branded insurance companies provide this offering,” said EM2P2’s Luce.

One medical marijuana provider that’s signed onto the ACCM/EM2P2 platform – called CannaLnx – is Kolas, which operates six retail shops serving both MMJ patients and recreational customers in Sacramento, California.

Medical marijuana patients account for about 5% of customers at Kolas, said Kevin McCarty, the company’s compliance director.

McCarty projects the number of MMJ patients will increase by about 5% when they are able to be reimbursed for the products.

“It’s going to be a big opportunity,” he said.

“With the strain in the economy and people being tight with funds, being able to be reimbursed for medical cannabis … could be a game-changer.”

What about marijuana rescheduling?

One of the biggest challenges to true insurance coverage is federal cannabis prohibition.

Without clear regulations and measurable standards for doctor-patient-insurer relationships, insurance companies are hesitant to step in.

Downgrading cannabis’ status under federal law, as President Donald Trump has promised to consider, could help break the logjam in Washington blocking broader marijuana reform.

Officially accepting marijuana as a medicine, as moving cannabis to Schedule 3 of the Controlled Substances Act would do, could encourage the significant regulatory changes needed for Medicaid or the Veterans Health Administration to cover MMJ.

That in turn could pave the way for private insurers to follow. But in the meantime, practical options are limited.

“There’s a lot of people talking about what insurance coverage would look like, but the only place it’s happening is in a few states that have worker’s comp reimbursement,” Sherer said.

While Sherer hopes to see insurance coverage for cannabis in the future, she remains skeptical that the current players in the market will deliver.

For now, she said, the focus should remain on integrating cannabis into the broader healthcare system and ensuring that patients – not just businesses – benefit from any progress that’s made.

“People aren’t asking, ‘What about the patients?’,” Sherer said.

“But the patients are why we’re here – all of these businesses are a byproduct of patient advocacy.”

True medical marijuana coverage could save lives, slash costs

ACCM and EM2P2’s announcement of the Elevated States effort comes just a few weeks after Trump posted a video produced by The Commonwealth Project, another MMJ advocacy organization, on his Truth Social site.

The video highlighted the endocannabinoid system and the potential benefits of cannabidiol (CBD) for senior healthcare and suggested that the U.S. healthcare system would save $64 billion in cannabis is fully integrated into the healthcare system.

Not only would covering the cost of medical marijuana save the healthcare system money, but it would also save the lives of at least 50,000 patients a year who are prescribed prescription drugs, said Dr. Mikhail Kogan of the GW Center for Integrative Medicine in Washington, D.C.

Kogen points to CBD drug Epidiolex, a pharmaceutical-grade cannabis product used to treat seizures that costs $30,000 per year. Insurance covers Epidiolex for 97% of patients with Dravet syndrom and TSC.

In contrast, high-quality CBD from reputable distributors can cost as little as $300 annually.

“Even if I’m off tenfold and it’s $3,000, it’s still 10 times cheaper,” Kogan said.

The steep cost makes medical marijuana inaccessible for many ill people on Medicaid and fixed incomes, despite its potential to replace costly and dangerous medications.

“We can leave the infrastructure the way it is and put the burden on the patients, but we’ll have an increase in mortality every year,” Kogan said.

Margaret Jackson can be reached at margaret.jackson@mjbizdaily.com.